Provider Demographics
NPI:1811255664
Name:GEORGE, KALI (DMD)
Entity type:Individual
Prefix:DR
First Name:KALI
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N ASHLEY DR UNIT 914
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4365
Mailing Address - Country:US
Mailing Address - Phone:724-699-3679
Mailing Address - Fax:
Practice Address - Street 1:15277 AMBERLY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2155
Practice Address - Country:US
Practice Address - Phone:813-971-1688
Practice Address - Fax:813-971-4322
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 200541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice